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E

eckerts

Guest
What is the name of your state? Florida

I was recently diagnosed with lumbar disc degeneration. In 2000 I had surgery for 2 different disc herniations. My surgeon ordered an MRI. He did not agree with the radiologist reading of the test...they stated I had post surgical changes and possible disc bulging. My surgeon showed me the films and my bottom 2 discs are very thin black lines while my others are thick and white (healthy discs) I am unable to sit at the present time. Within minutes pain shoots down my buttox and legs. My job is on the computer working for a hospital taking phone calls all day. We are required to meet 6 hours of on line time a day (sitting at our desks taking calls). Prior to my leave on Sept. 9th, my supervisor had called me into her office to inform me that I am not meeting this on line time requirement and to see if there was a problem. I explained my back pain and that I was having to get up and move around quite often just to get through the day.

When I saw my Dr. he listed my restrictions...no sitting, lifting, bending or twisting. no driving...basically bed rest until we could get the inflamation down. He told me this would prevent spinal root injury. I was placed on a steroid pack, Bextra (a new anti inflamitory) lortab 10's and told to go for physical therapy. I was told that I needed surgery. If I have a fusion at my age (31) then the chances of more problems later in life was great...however a new procedure spinal disc replacemetn is just being FDA approved and my surgeon felt we should do all possible so I can hold out for this...including when I do have to go back to work (my employer will only hold my job for 12 weeks) ESI injections to try and help me through the day. I also have a portible 10's pack.

My employer aproved my leave and informed me that in order to return I must meet my 6 hours required time every day and I may not take any prescribed pain meds while on the job.

My accumiliated paid time off ended Oct. 1. I filed a claim with my short term disability insurance. They received my MRI report and Dr's office visit notes. They denied my claim stating that the information does not support that I am disabled and that people with DDD work all the time.

I explained to then that I have to sit all day and at present until the swelling is down my physician does not want me sitting. If I do it may cause nerve root damage, which could lead to permanent problems. They told me that I should just have the fusion and they would begin to pay my benefits. I feel it is my right to hold out for the availibility of the better procedure.

I can appeal, but they have reviewed my case twice already and come back with the same findings....How do I prove disability??????

The insurance company has the notes from my Dr stating that I may not sit or drive...both needed for me to work, and they have infromation from my employer stating that I need to be able to sit for extended periods without the pain medication. I have researched DDD on line and every site informs me that people have dibilitating pain that keeps them for doing their job and day to day activities. It also states that preventing nerve root problems is imperative. At this point I dont know what to do. My Dr wont release me until Dec 1, and my work wont take me back until he gives the ok and my insurance wont pay. Now that I have drained my savings I am in a rut.
 


ellencee

Senior Member
eckerts
If you have appealed this decision by using the policy's terms and conditions for meeting short-term disability and providing medical proof (MD statements) for each term and condition, and still you are being denied your benefits as contracted, send a complaint of "bad faith" to the insurance commissioner of your state. In your complaint of bad faith by your insurance company, be sure to state the dates you applied for benefits, the dates of appeals, and enclose copies of all correspondence between you and the insurance company and enclose all medical reports from your physician.

If the insurance company has intentionally denied your benefits to which you are legally entitled and the insurance commissioner finds that the insurance company has acted in bad faith, you will get your ST benefits and you may be entitled to recover punitive damages from the insurance company (more money). If the insurance commissioner makes a finding of bad faith by the insurance company, consult with an attorney at once and pursue filing a lawsuit against the insurance company.

EC
 
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